Surgical treatment of axial hiatal hernia-reflux complex by Nissen fundoplication. A cineradiologic and manometric study.

This study was undertaken to review our result in the surgical treatment of the axial hiatal hernia-reflux complex with Nissen fundoplication using cineradiologic, manometric, and endoscopic studies and an analysis of objective symptoms of the patients as criteria in evaluation. During the period 1966-1975 86 patients underwent Nissen fundoplication at Oulu University Central Hospital. In 50 of the 86 patients it was possible to carry out thorough pre- and postoperative examinations and a long-term follow-up using the aforementioned methods. There was some discrepancy between objective and subjective postoperative results. During the 10-year follow-up period, mean 5 years, the recurrency frequency was 14% (7/50), but 22% (11/50) of the patients considered the postoperative result subjectively to be poor. On the other hand, 3 patients with a definite recurrence considered the end result subjectively to be good. On the basis of these findings we were able to conclude that the objective postoperative examinations in themselves are not sufficient for thorough, long-term evaluation of postoperative results, but that the patient's subjective postoperative symptoms and his opinion of the success or failure of the operation should also be taken into consideration.